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July 2001
Utility of fine-needle aspiration biopsy and flow cytometry in the diagnosis and classification of primary and recurrent malignant lymphoma
Fine-needle aspiration biopsy offers the potential for rapid diagnosis with minimal attendant morbidity. Although limited in scope by the fact that only positive cases were reviewed, this study addressed the usefulness of fine-needle aspiration biopsy with and without flow cytometry in the diagnosis and subclassification of malignant lymphoma. This retrospective analysis included 139 consecutive cases (84 primary and 55 recurrent lymphomas) obtained between 1995 and 1997. Flow cytometry was performed successfully in 105 (75 percent) cases. Overall, 93 cases (67 percent) were considered true-positive, seven (five percent) false-negative, 27 (19 percent) suspicious, and 12 (nine percent) atypical. In those cases with successful flow cytometry, 77 percent were positive with no false-negatives, 14 percent were suspicious, and nine percent were atypical. Of the primary lymphomas, 74 percent were found to be true-positives using both techniques. Diagnostic accuracy varied among lymphoma subtypes, with 77 percent of all cases being able to be subclassified on review, although subclassification initially was accomplished in only 59 percent. Subclassification was best for small lymphocytic lymphoma/chronic lymphocytic leukemia, lymphoplasmacytic lymphoma, Burkitt’s lymphoma, mantle cell lymphoma, and plasmacytoma. Subclassification was poor for marginal-zone lymphoma and Hodgkin’s disease. Although initially poor, review subclassification was also good for large cell lymphoma and follicular lymphoma. The authors concluded that, “Although a diagnosis and proper subclassification of lymphoma can be made with certainty in the majority of cases, recurrent or primary, it requires close coordination of cytomorphology and immunophenotyping data, which often comes with close cooperation of cytopathologists and hematopathologists.”
Dong HY, Harris NL, Preffer FI, et al. Fine-needle aspiration biopsy in the diagnosis and classification of primary and recurrent lymphoma: a retrospective analysis of the utility of cytomorphology and flow cytometry. Mod Pathol. 2001;14(5):472-481.
Reprints: Dr. Martha B. Pitman, Dept. of Pathology, Warren 2, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114; mpitman@partners.org
Hürthle cell carcinoma
Considerable controversy surrounds the ability of morphology to predict biological behavior for Hürthle cell tumors. The authors studied 73 cases of Hürthle cell tumors of the thyroid, excluding Hürthle cell adenomas, identified at Memorial Sloan-Kettering Cancer Center between 1956 and 2000. Of the 102 cases initially reviewed, 29 were rediagnosed, including 25 that were reclassified as the tall cell variant of papillary carcinoma. The remaining Hürthle cell tumors were classified as tumors of unknown malignant behavior (solid/trabecular growth pattern or incomplete capsular invasion, or both), minimally invasive carcinoma (a single focus of intra- or extracapsular vascular invasion or a single focus of complete capsular invasion, or both), and widely invasive carcinoma (more than one focus of vascular invasion or more than one focus of capsular invasion, or both). Seventeen tumors fell into the first group, 23 into the second, and 33 into the third. At a median followup of eight years, no patients with a tumor of unknown malignant potential or minimally invasive carcinoma relapsed or died of their disease. Of the other patients with widely invasive carcinoma, 73 percent relapsed and 55 percent died of tumor. Adverse predictors by univariate analysis included extra thyroidal extension, nodal metastasis, positive margins, and a solid growth pattern. Furthermore, capsular and vascular invasion were associated with a worse disease-specific survival rate. Extra thyroidal extension and nodal metastasis were independent predictors of outcome using multivariate analysis. The authors noted that the prognosis for patients with Hürthle cell carcinoma is predicted by well-defined histomorphologic characteristics.
Stojadinovic A, Ghossein RA, Hoos A, et al. Hürthle cell carcinoma: a critical histopathologic appraisal. J Clin Oncol. 2001;19:2616-2625.
Reprints: Dr. Bhuvanesh Singh, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021; singhb@mskcc.org
Prognosis for primary cutaneous large B-cell lymphoma
The authors investigated 32 cases of cutaneous large B-cell lymphoma, which represented a subgroup of 126 primary cutaneous B-cell lymphomas collected from several hospitals in Spain. Inclusion criteria for the study included a well-documented clinical followup spanning at least six months after diagnosis, availability of formalin-fixed, paraffin-embedded material, and disease limited to the skin for at least six months after diagnosis. In addition to morphological assessment, a variety of immunohistochemical studies were performed, including p53, MIB1, Bc12, Bc16, and CD10. Histological evaluation was used to divide the 32 patients into three groups: grade III follicular lymphoma (11), monomorphous large B-cell lymphoma (six), and large B-cell lymphoma with admixed small lymphocytes (15). Only one patient died during the course of followup, but failure-free survival at 48 months was only 0.46, with five cutaneous and four lymph node relapses. Time to relapse ranged from zero to 192 months (mean, 35 months). Analysis of the subgroups revealed that grade III follicular lymphoma tended to be found in the head and neck and showed CD10 expression in the majority of cases. Moreover, patients whose tumor presented at this site and who were CD10 positive were more likely to experience lymph node relapses than patients who lacked these features. The authors’ data “strongly supports that the immunophenotype and clinical evolution of primary cutaneous LBCL differs significantly from cases originating in the lymph nodes.” They noted “differences in presentation, low tendency to systemic spread, and more favorable outcome” for this group of lymphomas.
Fernandez-Vazquez A, Rodriguez-Peralto L, Martinez MA, et al. Primary cutaneous large B-cell lymphoma. The relation between morphology, clinical presentation, immunohistochemical markers, and survival. Am J Surg Pathol. 2001;25(3):307-315.
Reprints: Dr. Miguel A. Piris, Programa de Patología Molecular, Centro Nacional de Investigaciones Oncologicas, Ctra Majadahonda-Pozuelo, Km 2, 28220 Majadahonda, Madrid, Spain; mapiris@cnio.es
Uterine endometrioid carcinoma: a novel binary grading scheme
The FIGO (International Federation of Gynecology and Obstetrics) grading scheme is difficult to apply because it requires assessment of the percentage of solid areas within a uterine endometrioid carcinoma, distinction of squamous from nonsquamous growth, and distinction between the narrow spectrum of nuclear atypia. The authors described a novel scheme for grading uterine endometrioid carcinoma tumors. The architectural criteria used to segregate tumors into low and high grade included more than 50 percent solid growth (without distinction of squamous from nonsquamous epithelium and based on low-magnification assessment); tumor cell necrosis; and a diffusely infiltrative, rather than expansive, growth pattern. The tumor is labeled high grade when at least two of these three criteria are present. For tumors confined to the endometrium, only the first two criteria are assessed, and tumors that have both features are considered high grade. This grading scheme identified a previously unreported subset of patients with high-stage, low-grade tumors who had a five-year survival rate of 67 to 76 percent. The inter- and intraobserver reproducibility of this scheme was greater than that of the FIGO and nuclear grading schemes. But the reproducibility and clinical relevance of this grading scheme needs to be tested further.
Lax SF, Kurman RJ, Pizer ES, et al. A binary architectural grading system for uterine endometrial endometrioid carcinoma has superior reproducibility compared with FIGO grading and identifies subsets of advance-stage tumors with favorable and unfavorable prognosis. Am J Surg Pathol. 2000:24; 1201- 1208.
Reprints: Dr. Robert J. Kurman, Dept. of Pathology, The Johns Hopkins Medical Institutions, Pathology 711, 600 N. Wolfe St., Baltimore, MD 21287
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